A person with red spots on their hands, feet, arms and legs crouches on the ground against a night sky.

Dealing with Cryoglobulinemia and Hepatitis C

Hepatitis C patients can sometimes experience joint and muscle pain, which can be a sign of a blood disorder called cryoglobulinemia.

Cryoglobulinemia: What’s That?

Cryoglobulinemia is a blood disorder where abnormal proteins in the blood clump together, causing the blood to become thicker in low temperatures. These protein clumps can interfere with normal blood circulation and damage the skin, joints, nerves, and organs, especially the liver and kidneys.

Cryoglobulinemia is considered a type of vasculitis (enlargement of the blood vessels).

Cryoglobulinemia is commonly associated with hepatitis C and its co-infections. Cryoglobulinemia is also associated with other conditions such as blood cancers like lymphoma, multiple myeloma, and connective tissue diseases like lupus.

Types of cryoglobulinemia

There are three types of cryoglobulinemia:

  • Type 1: Monoclonal
  • Type 2: Mixed
  • Type 3: Mixed, Polyclonal

Type 2 and 3 involve rheumatoid factor activity, which results in joint and muscle pain.

Type 2 and 3 are most commonly seen in patients with hepatitis C. Approximately 50% of patients with chronic hep C have mixed cryoglobulinemia; However, only 3% experience symptoms.

It is recommended for all hepatitis C patients to be tested for cryoglobulinemia (as well as patients who have kidney disease).


Symptoms of cryoglobulinemia may include:

  • Joint and muscle pain
  • Purple spots or blotchy areas on the legs
  • Tingly and numbness in the toes and fingers

Other possible symptoms:

  • Raynaud’s Phenomenon (color change in hands or feet from normal/white to purple/bluish color in cold temperatures)
  • Weight loss
  • High blood pressure
  • Swelling of ankles and legs
  • Enlarged liver or spleen
  • Skin ulcers and gangrene
  • Weakness in strength
  • Numbness and tingling
  • Kidney damage


There is a special blood test to detect cryoglobulins in the blood. Other blood tests need to be run to determine if other body functions or organs have been affected.


For patients with hepatitis C and cryoglobulinemia, treatment with direct-acting anti-viral medications for hepatitis C is typically the recommended course of treatment and usually prevents recurrence of cryoglobulinemia.

Symptoms normally resolve after treatment, as long as there is no permanent damage to the internal organs or nerves. After treatment, the long-term prognosis is typically excellent.

If other organs have been affected, your doctor may recommend other treatments or medications (such as corticosteroid) to help relieve symptoms. Before starting treatment for cryoglobulinemia, your doctor will consider all your medical conditions as well as the condition of your liver.

If you have hepatitis C - or have symptoms such as joint and muscle - talk to your physician about testing for cryoglobulinemia.

Have you experienced symptoms of joint and muscle pain with hepatitis C? Tell us below!

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